The current American health care system with its obscene profit incentives and increasingly impersonal nature undermines the essential point of all prior medical knowledge, namely an ounce of prevention is worth a pound of cure. It gives essentially the promise of medical care without the substance of quality care. It is increased nurse patient ratios stretched by ever expanding workloads and less individualized attention to patient needs. It is the substitution of doctor's orders and prescriptions by cost care analysts and accountants not health care professionals.
While HMO's and insurance companies decided how much care and at what price working families lucky enough to afford its premiums are doled out, a vastly expanding number of as many as 47 million Americans have no coverage at all and there are 50 million more who are under insured and are plagued by chronic illnesses. This is almost one in three of all Americans who are affected by a broken healthcare system.
The economic downturn has increased the numbers of people without health insurance and also threatens millions of people who have insurance but find that the coverage is inadequate or that they cannot afford their rising medical costs. Many of the 160 million people covered by employer health insurance are struggling to meet medical expenses that are much higher than they used to be — often because of some combination of higher premiums, less extensive coverage, and bigger out-of-pocket deductibles and co-payments. With medical costs rising, the coverage many people have may not adequately protect them from the financial pain of an emergency room visit or a major surgery. For some, even routine doctor visits might now be postponed for basic expenses like food and gasoline.
Our American Quality of Life is a Right that must and should include access to affordable and quality health care. It should guarantee the respect and dignity for our disabled and aged as well as our children and lower our infant mortality, which has become one of the worst rates in the industrialized world. Health care for all should be one of the guarantees, rights, and responsibilities to all our citizens and based on special circumstances, not political slogans.
Compared with the residents of other countries, Americans pay much more for brand-name prescription drugs, less for generic and over-the-counter drugs, and roughly the same prices for biologics. I believe it would be beneficial to allow Medicare to negotiate with manufacturers for lower prescription drug prices and to allow cheaper drugs to be imported from abroad as long as they maintain standards of quality.
Less than half of all medical care in the United States is supported by good evidence that it works, according to estimates cited by the Congressional Budget Office.
If doctors had better information on which treatments work best for which patients, and whether the benefits were commensurate with the costs, needless treatment could be junked, the savings could be substantial, and patient care would surely improve. It could take a decade, or several, to conduct comparative-effectiveness studies, modify relevant laws, and change doctors’ behavior.
A classic experiment by Rand researchers from 1974 to 1982 found that people who had to pay almost all of their own medical bills spent 30 percent less on health care than those whose insurance covered all their costs, with little or no difference in health outcomes. The one exception was low-income people in poor health, which went without care they needed. Any cost-sharing scheme would have to protect those unable to bear the burden.
If the entire nation could bring its costs down to match the lower-spending regions of the US that are more cost efficient, the country could cut perhaps 20 to 30 percent off its health care bill, a tremendous saving. That would require changing the long- ingrained practices of the medical profession. Public and private insurers might need to revise coverage for high-cost care that adds little value.
The American health care system lags well behind other sectors of the economy — and behind foreign medical systems — in adopting computers, electronic health records and information-sharing technologies that can greatly boost productivity. There is little doubt that widespread computerization could greatly reduce the paperwork burden on doctors and hospitals, head off medication errors, and reduce the costly repetition of diagnostic tests as patients move from one doctor to another. Without an infusion of capital, the transition from paper records is not apt to happen very quickly.
In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.
But there is little dispute that the general practice of medicine is under strain at a time when there is bipartisan consensus that better prevention and chronic disease management would not only improve health but also help control costs. With its population aging, the country will need 40 percent more primary care doctors by 2020, according to the American College of Physicians, which represents 125,000 internists, and the 94,000-member American Academy of Family Physicians. Community health centers, bolstered by increases in federal financing during the Bush years, are having particular difficulty finding doctors.
There have been slight increases in the number of doctors training in internal medicine, which focuses on the nonsurgical treatment of adults. But the share of those residents who then establish a general practice has plummeted, to 24 percent in 2006 from 54 percent in 1998, according to the American College of Physicians. While fewer American-trained doctors are pursuing primary care, foreign medical school graduates and osteopathic doctors are replacing them in droves. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.
Numerous studies, in this country and others, have shown that primary care improves health and saves money by encouraging prevention and early diagnosis of chronic conditions like high blood pressure and diabetes. Presidential candidates in both parties stress its importance. Officials with several large health systems said their primary care practices often lose money, but generate revenue for their companies by referring patients to profit centers like surgery and laboratories.
There is a growing political consensus among Democrats that universal health care can be achieved by subsidizing coverage for low-income people, establishing new purchasing pools to help others buy affordable insurance, and requiring most businesses to offer health plans to their workers or pay a fee.
Most proposals contain these elements, as well as the option to buy into a public plan. There are striking difference is on whether to require everyone to get a policy or have a universal mandate. Backers say the lack of a mandate would doom any universal coverage system. Critics of the individual mandate say forcing people to obtain insurance is unfair and ineffective, but without one only the sick and those most likely to need care buy in, insurers would need to charge higher premiums. That, in turn, would make policies harder to afford and increase pressure on the government to further subsidize the plans, driving up the overall cost.
Governmental budgets will face the crisis even sooner. States are already complaining that they have to crimp other vital activities, like education, to meet soaring Medicaid costs. And federal spending on Medicare and Medicaid is surging upward at rates that will cause the deficit to soar. That means politicians will have to raise taxes, severely cut a wide range of other governmental programs, or chop back the health programs themselves.
We need only to revisit the recent tragedies at one of our major Universities to also explore the failure in the mental health sector. We have failure by a system beset with guidelines that require a direct emergency to provide and sustain help to many Americans. We also have failure by a system that turns away many Americans and allows insurance companies to cap lifetime benefits without regard to personal needs or safety.
We should hold as inviolate the relationship between a patient and their health care professional, not between an insurance company and a drug manufacturer, just as we hold as inviolate the relationship between the clergy and their ministry, and between an attorney and their client. They all need be an essential part of the free and just exercises of Life, Liberty, and The Pursuit of Happiness in any future America.
-Thomas P Love
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